Name of the Procedure:

Fistulization of Sclera for Glaucoma; Sclerectomy with Punch or Scissors, with Iridectomy

Summary

This surgical procedure involves creating an opening in the sclera (the white part of the eye) to allow excess fluid to drain and relieve pressure inside the eye. It includes removing a portion of the sclera and the iris to facilitate drainage.

Purpose

The procedure addresses glaucoma, a condition characterized by increased intraocular pressure, which can damage the optic nerve and lead to vision loss. The goal is to lower eye pressure and prevent or reduce damage to the optic nerve, thereby preserving vision.

Indications

• Elevated intraocular pressure unresponsive to medications or other treatments.
• Progressive optic nerve damage despite treatment.
• Severe glaucoma symptoms such as eye pain, blurred vision, or halos around lights.
• Specific types of glaucoma, such as primary open-angle glaucoma or secondary glaucoma.

Preparation

• Patients may be advised to fast for 8 hours prior to the procedure.
• Medications, particularly blood thinners, may need to be adjusted or paused.
• Pre-operative eye assessment and imaging tests to evaluate eye structures.
• Informing the surgeon of any allergies or underlying health conditions.

Procedure Description

1. The patient is given local or general anesthesia to ensure comfort.
2. A small incision is made in the sclera.
3. Using a punch or scissors, a portion of the sclera and iris is removed to create a drainage channel.
4. The new channel allows aqueous humor (eye fluid) to exit the eye and reduce pressure.
5. The incision site is usually sutured closed, and a sterile bandage is applied to the eye.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is usually performed in a hospital or specialized surgical center.

Personnel

• Ophthalmic surgeon
• Surgical nurses
• Anesthesiologist (if general anesthesia is used)

Risks and Complications

• Infection
• Bleeding
• Swelling or inflammation
• Vision changes or loss
• Scarring that may block fluid drainage
• Cataract formation
• Hypotony (abnormally low eye pressure)

Benefits

• Significant reduction in intraocular pressure
• Prevention of further optic nerve damage
• Preservation of remaining vision
• Relief from glaucoma symptoms

Recovery

• Post-procedure instructions typically include using prescribed eye drops to prevent infection and control inflammation.
• Avoid strenuous activity and protect the eye from injury.
• Regular follow-up appointments to monitor eye pressure and healing.
• Recovery time varies, but patients usually return to normal activities within a few weeks.

Alternatives

• Medications (eye drops, oral medications)
• Laser treatments (trabeculoplasty or cyclophotocoagulation)
• Other surgical options (trabeculectomy, glaucoma drainage implants)
• Each alternative has its own benefits and risks; some may be less invasive but might not provide as significant or lasting pressure reduction.

Patient Experience

During the procedure, the patient is typically comfortable due to anesthesia. Post-procedure, there may be mild discomfort, irritation, or blurry vision as the eye heals. Pain management is usually effective with prescribed medications, and vision gradually improves as recovery progresses.